Emergency contraception: what to do after unprotected sex

Emergency contraception (EC) is a way to prevent pregnancy after unprotected sex. It is not the same as abortion — it stops a pregnancy from starting.

You may need EC if:

• A condom broke or slipped off
• You missed 2 or more birth-control pills
• You were late for your Depo injection
• You were forced or pressured into sex
• You had sex without any contraception

The sooner you take EC, the better it works. Get it today.

On this page

• Two main options
• How well they work
• Side effects
• Where to get EC
• What EC does NOT do
• After taking EC
• If it fails

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Two main options

1. Emergency contraceptive pill (levonorgestrel)

• Brand names in Ethiopia: Postpill, Plan B, Norlevo
• Where: any pharmacy, no prescription needed, no age limit
• When: works up to 72 hours after unprotected sex — best within 24
• How: one tablet of 1.5 mg, or two tablets of 0.75 mg together
• Cost: about ETB 30-100 per dose

Some pharmacies also stock ulipristal acetate (ellaOne) which works for up to 5 days and is slightly more effective. Ask for it if available.

2. Copper IUD

• Where: government health centre, Marie Stopes, FGAE — free or low cost
• When: works up to 5 days (120 hours) after unprotected sex
• How: a health worker inserts a small copper device into the womb
• Bonus: stays in as long-term contraception for up to 12 years

The copper IUD is the most effective form of EC (over 99%) AND it becomes your ongoing contraception. If you’re willing to have it fitted, it’s the best option.

How well they work

Effectiveness drops with every hour of delay.

When taken	Levonorgestrel pill	Ulipristal pill	Copper IUD
Within 24 hours	95%	97%	>99%
24-48 hours	85%	95%	>99%
48-72 hours	58%	90%	>99%
72-120 hours	Not effective	85%	>99%

“Effective” here means the pill/IUD stops the pregnancy that would have happened. It doesn’t guarantee no pregnancy — but reduces the chance a lot.

Side effects

The pill is safe for almost everyone. Common side effects — all short-lived:

• Nausea (10-20% of women)
• Headache
• Dizziness or tiredness
• Breast tenderness
• Your next period may come a few days earlier or later than usual
• Sometimes light spotting for 1-2 days

If you vomit within 2 hours of taking the pill, take another dose — the first one may not have absorbed.

The copper IUD side effects:

• Cramping for 1-2 days after insertion
• First few periods may be heavier and longer than usual
• Insertion is uncomfortable but not usually painful (paracetamol beforehand helps)

Where to get EC

• Pharmacies — the pill, over the counter, no ID required
• Government health centres — free, both pill and copper IUD
• Marie Stopes Ethiopia — both options
• FGAE clinics — youth-friendly, both options
• Hospital emergency departments — after sexual assault (also for PEP + STI screening — see below)

Confidential. No partner or parent permission needed at any age.

What EC does NOT do

::: dontList

EC is not:

• Not an abortion pill. EC prevents pregnancy from starting. If you’re already pregnant, EC doesn’t do anything. Confusion between EC and mifepristone/misoprostol is common — they are different medicines.
• Not birth control for regular use. The pill is less effective per act than daily contraception, and side effects are worse if used often. Use regular contraception (pill, injection, implant, IUD, condom) for ongoing needs.
• Not protection against HIV or STIs. If the sex was unprotected, get tested for STIs and consider PEP (post-exposure prophylaxis for HIV) within 72 hours — see the HIV testing article. :::

After taking EC

• Your period should come within 3 weeks. If it’s more than 7 days late, take a pregnancy test.
• Continue any regular contraception if you’re on it. If you missed pills that triggered this, restart pills the next day.
• Use condoms until your next period — sperm from EC-day sex or subsequent sex may still cause pregnancy in the same cycle.

If EC fails

If you take EC and still get pregnant:

• The medicine itself does NOT harm the developing pregnancy (studies show no birth-defect risk)
• You have options: continue the pregnancy, or terminate under Ethiopia’s abortion law (legal on several grounds including rape, incest, and risk to health)
• Talk to a health worker about your options — no judgement

After sexual assault

If you were raped:

::: urgentAdvice severity=“urgent”

Go to a hospital or Marie Stopes clinic today. You need:

1. Emergency contraception (as above)
2. PEP — 28-day HIV prevention treatment, most effective if started within 72 hours
3. STI screening + prevention — for gonorrhoea, chlamydia, syphilis
4. Medical evidence collection — for legal proceedings if you choose to report
5. Counselling and support

One-Stop Centres for sexual assault are available in most major hospitals in Ethiopia and provide all of the above in one visit. They are confidential — you don’t have to report to police unless you want to.

Support hotlines:

• Association for Women’s Sanctuary and Development (AWSAD): 011 663 3888 (Addis Ababa)
• Regional numbers vary — ask any hospital or Marie Stopes clinic :::

When to also see a health worker

• If you use EC more than once a month, get help finding a regular contraception method that works for you
• If your period is more than 7 days late after EC
• If you have severe pain, heavy bleeding, or feel unwell after EC
• If you were sexually assaulted (see above)

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Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa

Sources: WHO Emergency Contraception fact sheet 2021; WHO Medical Eligibility Criteria 5th ed; Ethiopian MoH National Reproductive Health Strategy 2021.

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Draft notes: ~1050 words · grade 7 · isTimeCritical true · Ethiopian context: over-the-counter access, real prices, One-Stop Centres for assault, AWSAD hotline, Marie Stopes + FGAE, notes on Ethiopia’s abortion law without going deep · Cross-references HIV testing (PEP), family planning · Sensitive — needs sensitive review before publish.